Department of Cardiothoracic Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China Department of Anesthesiology, West China Hospital of Medicine, Sichuan University, Sichuan, 610017, China.
Int J Surg. 2021 Nov;95:106163. doi: 10.1016/j.ijsu.2021.106163. Epub 2021 Nov 4.
Postoperative cognitive dysfunction (POCD) is a common complication of central nervous system in middle-aged and elderly patients after cardiac surgery. The purpose of this study was to review the progress in diagnosis, pathogenesis and risk factors and control strategy of POCD.
A systematic literature search was conducted using Pubmed and EMBASE, using the Mesh terms and key words "POCD", "diagnostic criteria", "pathogenesis", "influencing factors" and "prevention strategies". Studies were retained for review after meeting strict inclusion criteria that included only prospective studies evaluating risk factors for POCD in patients who had elective cardiac surgery. Diagnosis of POCD needed to be confirmed using the Diagnostic and Statistical Manual of Montreal Cognitive Assessment (MoCA) Scale and other criteria.
"Twenty two articles were selected for inclusion. The incidence of POCD across the studies ranged from 9% to 54%. Multiple factors have been associated with the pathogenesis and increased risk of POCD, including neuroinflammation, dysfunction of cholinergic system, abnormal protein function (β-amyloid), old age, anesthetic, surgical and other factors."
POCD is a common complication after cardiac surgery in elderly. The highest POCD incidence was observed after open aortic, TAVI and CABG surgery. Age, cognitive function, depression, CPB and anesthetic use are leading risk factors. Further research is needed in determining interventions that will be effective in preventing and treating POCD in cardiac surgical setting.
术后认知功能障碍（POCD）是中老年患者心脏手术后中枢神经系统的常见并发症。本研究旨在综述 POCD 的诊断、发病机制和危险因素及控制策略的研究进展。
通过 Pubmed 和 EMBASE 系统检索文献，使用 Mesh 术语和关键词“POCD”“诊断标准”“发病机制”“影响因素”和“预防策略”。保留符合严格纳入标准的研究进行综述，这些标准仅包括评估择期心脏手术患者 POCD 危险因素的前瞻性研究。POCD 的诊断需要使用蒙特利尔认知评估量表（MoCA 量表）和其他标准来确认。
“共纳入 22 篇文章。研究中 POCD 的发生率从 9%到 54%不等。多种因素与发病机制和 POCD 风险增加有关，包括神经炎症、胆碱能系统功能障碍、异常蛋白功能（β-淀粉样蛋白）、年龄、麻醉、手术和其他因素。”
POCD 是老年人心脏手术后的常见并发症。在开放主动脉、TAVI 和 CABG 手术后，POCD 的发生率最高。年龄、认知功能、抑郁、CPB 和麻醉的使用是主要的危险因素。需要进一步研究确定在心脏手术环境中预防和治疗 POCD 的有效干预措施。
